transfusion reactions Flashcards
what causes an immediate hemolytic transfusion rxn?
ABO incompatible units
complement binding to C9 = intravascular hemolysis
how long until an immediate hemolytic reaction and what are the symptoms
immediate 1-15 mins with fevers, chills, chest pain, and hemoglobinuria
progression: low BP, shortness of breath, nausea, burning along the vein, angioedema, back pain, anxiety, DIC, death
what is the treatment of an immediate hemolytic
supportive care
what are other rare non ABO causes of an immediate hemolytic reaction
pre formed antibody in the recipient
no antibody screen or antibody is too low frequency antigen (Cw, V, Kpa)
RBC unit is antigen positive (Kidd, Kell, Rh antibodies)
how can we prevent an immediate hemolytic reaction?
CLERICAL CHECKS, ensure every product leaving the lab is AB compatible
what is the cause of a febrile non hemolytic reaction?
soluble vasoactive cytokines in the product (often plt) from WBC breakdown
HLA antibodies in patient that react with donor wbc
symptoms of a febrile non hemolytic
fever with or without chills
treatment of a febrile non hemolytic reaction
acetaminophen, rule out other fever causing reactions
universal pre-storage leukoreduction has helped reduce febrile reductions
what is the cause of a mild allergic (urticarial) reaction
mild allergic results from IgE antibodies in patient reacting with an allergen in the donor plasma (food, protein, preservative)
- antibodies bind mast cells which release granular contents (histamine) to give symptoms of urticarial (hives) and pruritis (itching)
have mild cardiac symptoms but BP is stable
timing of a mild allergic reaction
1-45 mins start of transfusion
treatment of mild allergic reaction
antihistamines - can transfuse slowly
cause of a severe anaphylactic reaction
due to donor IgA antibodies (it is the antigen)
recipient is IgA deficient and makes anti-IgA from previous transfusions
Anti-Iga- IgA interactions leads to severe anaphylaxis
can be allergen in donor plasma but is rare (like peanuts)
IgE Mast cells degranulation
timing of a sever anaphylactic reaction
within minutes of infusion (1-15 mins) can start mild allergic and progress
symptoms of sever anaphylactic
- urticaria, pruritis, SOB, dyspnea, low BP, hypoxemia, GI
- smooth muscle contraction - GI, trachea, bronchi, bronchioles
- vasodilation - drop in blood pressure
treatment of severe anaphylactic
epinephrine, antihistamines, corticosteroids, supportive therapy
prevention of a severe anaphylactic reaction
request IgA deficient products
1/1000 people are IgA deficient
wash rbc/plt units
transfuse with caution
cause of a bacteriogenic reaction
bacteria in blood product from
- normal skin flora from donor arm
- transient bacteremia in donor
- contamination of product during processing/ product manipulation
- improper storage temperature
time of bacteriogenic reaction
minute - hours of toxins are present / high bacterial load in the bag several days if low microbial count - depends on patient’s immune status
storage of blood products that can cause a bacteriogenic reaction
platelets that are store at 20-24 degrees
red cells that can grow psychrophiles (0-25): e coli, pseudomonas, yersinia enterocolitica
symptoms of a bacteriogenic reaction
fever, chills, rigors, hypotension, flushing, clammy skin, tachycardia, DIC
treatment of a bacteriogenic reaction
broad spectrum antibiotics (do blood cultures aerobic and anaerobic)
culture the donor products/ empty bag if available
what is the cause of a delayed hemolytic reaction
antibody formation to non ABO antigens in donor blood (Rh, Kell, Kidd, Duffy, Ss)
antibodies bind donor cells and are removed by the liver and spleen (extravascular hemolysis)
timing of a delayed hemolytic trxn
2-14 days post transfusion, usually due to secondary exposure
products of a DH trxn
red blood cells
symptoms of a DH trxn
fevers, chills, malaise, jaundice or no symptoms
what is the treatment of a DH trxn
none!
monitor Hb, bilirubin, lactate dehydrogenase, and haptoglobin
what are the hematological tests we can test
hemoglobin should be increased if transfused properly
hemoglobin is either decreased or increased
increased bilirubin means increase hemolysis
increased lactate dehydrogenase
decreased haptoglobin
why is a positive DAT important post transfusion
a positive DAT is significant in a delayed hemolytic reaction
what are some other rare causes of a pos DAT post transfusion
- transfusion of a passive antibody
- transfusion if IVIg that binds non specifically to rbs
- donor is DAT pos
significance of the immune response curve
IgG antibody concentrations will increase after the secondary exposure and will bind to donor cells
indicators of IVH
- visible hemolysis present
- hemoglobinuria
- decreased haptoglobin
- increased LD
indicators of EVH
- increased bilirubin
- increased LD
- decreased haptoglobin
- decreased hemoglobin ( or Hb that fails to increase)
transfusion reaction investigation procedure:
- clerical check (bedside, in lab - pretransfusion req, specimen, donor bag)
- review symptoms
- note product transfused
- time of transfusion to symtoms
- volume transfused
- check for visible hemolysis on post transfusion sample
- perform serological testing - ABO Rh, antibody screen, DAT, XM
- perform non serological testing - Hem or CHem
a patient gets transfused and had an Abscr that was neg and XM that was neg, the post transfusion sample however has a neg Abscr, pos DAT, and a neg XM. what happened?
not enough antibody came up causing a neg Abscr
- happens closer to the beginning
eg. if anti-c present in the plasma -> will bind to donor cells in which less Ab left in plasma will be detected
when doing a transfusion reaction these are the results of a screen, DAT and XM. what happened?
Abscr: pos
DAT: neg
XM: pos
starting the reaction all donor cells tagged are removed.
collection of this sample was done at a later time
what is the delayed transfusion workup
- Ab ID if screen is positive
-perform elution on DAT pos cells - Ag type implicated donor segments
- do not Ag type patient if the have been transfused in the past 3 months
- update records
- serologically crossmatch with implicated donor units (should be pos)
- serologically crossmatch Ag neg donor for subsequent transfusions if XM is still valid (within 96 hours)
what testing is done on these samples in a transfusion reaction:
pretransfusion sample
posttransfusion sample
donor segment
pre: clerical check, ABO Rh, Ab screen, serological crossmatch
post: clerical check, check hemolysis, ABO Rh, Ab screen, DAT, serological XM
donor: clerical check, ABO Rh, antigen type for Ab detected in pre or post sample
